This article is more than 5 years old. Information may no longer be current.
Surgery ‘strongly recommended’ for difficult-to-treat rectosigmoid endometriosis
Click Here to Manage Email Alerts
Laparoscopic bowel resection improved pelvic pain and quality of life in women with rectosigmoid endometriosis did not respond to hormone therapy, according to new research.
These findings led investigators to “strongly recommend” surgery for these patients.
Some experts have argued that a more conservative surgery, in which the endometriotic nodule is shaved or removed, may reduce the risk for complications associated with the more radical bowel resection, according to Mads Riiskjær, MD, of the department of obstetrics and gynecology at Aarhus University Hospital in Denmark, and colleagues.
“The surgical strategy in this group of patients has been subject to debate in endometriosis circles for many years,” Riiskjær said in a video abstract. “Indeed, rectal resection is a procedure that carries a substantial risk of short- and long-term complications, and it has been argued that it is too radical an approach for a benign condition.”
Given this controversy, evaluated prospectively collected data on women who underwent laparoscopic bowel resection for rectosigmoid endometriosis between February 2011 and November 2015.
“Indication for surgery included severe pain and obstructive bowel symptoms unresponsive to medical treatment,” wrote.
Most of the patients (97.1%) completed questionnaires for pelvic pain and quality-of-life both before and 1 year after surgery, which showed significant reductions in all pelvic pain parameters (P = .0001), especially dyschezia, and significant improvements in quality-of-life scores (P = .0001). Notably, significantly more patients did not require hormone therapy (19% vs. 44%) or pain medication (6% vs. 38%) after surgery. Patients who experienced a surgical complication reported no negative impact on their outcome.
Riiskjær and colleagues also noted that they previously showed this procedure results in positive effects on urinary and sexual function.
“No two patients are identical and all factors including age, wish for pregnancy, and other personal and social factors should be taken into account in each case, but we strongly believe that our study supports a more aggressive surgical strategy in case of failed medical therapy, and apprehension about impairment of urinary and sexual function should not be a contraindication for bowel resection,” Riiskjær said in the video abstract.
Due to a lack of randomized studies comparing different surgical approaches, there remains no consensus on the best surgery for rectosigmoid endometriosis, and providers should therefore take a “patient-tailored approach,” and choose “the least invasive radical option,” according to a related editorial by Jean-Jacques Tuech, MD, PhD, and Horace Roman, MD, PhD, of Rouen, France.
“Like Riiskjær et al, we strongly believe that, in the future, research should focus on long-term outcome improvements of the multidisciplinary treatment for bowel endometriosis with regard to symptoms, quality of life, cosmetic outcome, recurrence, and fertility,” they wrote. “Other studies like [this] are strongly welcome because they will allow us to draw definitive conclusions.” – by Adam Leitenberger
Disclosures: The authors report no relevant financial disclosures.
Click Here to Manage Email Alerts